MEDICARE: FUNCTIONAL HEALTH INCORPORATED

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1083083539	OTHER	NY	IND NPI

General Provider Information

NPI Number	:	1023899002
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FUNCTIONAL HEALTH INCORPORATED

Provider Business Mailing Address
First Line	:	8015 231ST ST
Second Line	:
City	:	QUEENS VILLAGE
State	:	NY
Zip	:	11427-2107
Country	:	US
Telephone Number	:	646-236-6898
Fax Number	:	718-338-2695

Provider Business Practice Location Address
First Line	:	3130 GRAND CONCOURSE STE 1E
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10458-1263
Country	:	US
Telephone Number	:	212-203-3201
Fax Number	:	718-338-2695

Authorized Official
Title or Position	:	OWNER-OCCUPATIONAL THERAPIST
Name	:	ANTHONY KAHRL I BIGORNIA
Credential	:	OT
Telephone Number	:	646-236-6898

Provider Enumeration Date	:	10/06/2023
Last Update Date	:	10/06/2023

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Directions to “FUNCTIONAL HEALTH INCORPORATED ” Practice Location

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